An analysis of the demand for general surgeons in the Sallisaw, Oklahoma, medical service area

An Analysis of the Demand for General Surgeons in the Sallisaw, Oklahoma, Medical Service Area
Rural Development
Oklahoma Cooperative Extension Service
Oklahoma State University
Oklahoma Office of Rural Health
Center for Rural Health
Oklahoma State University
December 2010 AE-10124
An Analysis of the Demand for General Surgeons
in the Sallisaw, Oklahoma, Medical Service Area
Brian E. Whitacre, Assistant Professor and Extension Economist, OSU, Stillwater
405-744-6083; FAX 405-744-9835
Lara Brooks, Assistant Extension State Specialist, OSU, Stillwater
405-744-6083
Fred Eilrich, Assistant Extension State Specialist, OSU, Stillwater
405-744-6083
Gerald A. Doeksen, Regents Professor and Extension Economist, OSU, Stillwater
405-744-6083
Tony Yates - Sequoyah County Extension Director, Sallisaw
(918) 775-4838
Jack Frye - District Rural Development Specialist, Ada
(580) 332-4100
Corie Kaiser, Assistant Director, Oklahoma Center for Rural Health, Oklahoma City
405-840-6500
Val Schott - Director, Oklahoma Center for Rural Health, Oklahoma City
405-840-6500
Rural Development
Oklahoma Cooperative Extension Service
Oklahoma State University
Oklahoma Office of Rural Health
Center for Rural Health
Oklahoma State University
December 20101
An Analysis of the Demand for General Surgeons
in the Sallisaw, Oklahoma, Medical Service Area
Introduction
This report will examine the need for general surgeons in the Sallisaw, Oklahoma, Medical Service Area. Specifically, the study will:
1. Determine the definition of general surgeon by identifying procedures completed;
2. Determine the medical service area and population;
3. Estimate the potential number of general surgeries in the service area; and
4. Estimate the total demand for full-time equivalent general surgeons in the medical service area.
No recommendations will be made. The information included in this report is designed to assist local decision-makers in assessing the need and potential for general surgery services.
Importance of Rural Surgery
General surgeons in rural hospitals have the ability to not only generate revenue in rural areas, but also keep patients in the community for a variety of surgeries, other services, and even retail opportunities. Therefore, it is most likely that if patients leave the community for general surgery, they will then have an increased opportunity to leave the community for other services. Also, the absence of a general surgery-linked emergency department volume can have effects on revenue and overall quality of local services.
This study does not account for the number of current general surgeons or physicians practicing surgery in the Sallisaw service area. In addition to noting the importance of providing this service, it is equally important to first examine the need for general surgery in a given 2
service area. Moreover, this analysis will determine an estimate of the number of full-time general surgeons this service area can support.
Methodology for Determining Need of General Surgeons
This study will determine the “need” for general surgeons using an estimation of population-based need. This approach will estimate the number of potential procedures performed by a general surgeon by developing age and gender-specific coefficients and applying them to a specific service area population. These coefficients were derived from data obtained by the National Hospital Discharge Survey (NHDS) and the National Surgery of Ambulatory Surgery (NSAS). Both surveys are available through the National Center for Health Statistics [1,2].
While it is possible that many rural hospital service areas do not have an ample population to support a full-time equivalent (FTE) general surgeon, the demand is often sufficient to support a part-time surgeon. Due to expectations, some hospitals have 24 hour call coverage that employs additional surgeons beyond what is necessary to meet the population’s demand. This methodology estimates only the population-based need and does not account for additional surgeons to fill extended call, or call coverage.
Defining the services of a general surgeon is much more difficult than defining other medical services. Eilrich et al. (2010) note the variance in general surgery definitions and types of procedures completed [3]. Several factors account for this variance. Experience, training, and personal tastes and preferences all determine the variety of procedures each general surgeon completes. Since the focus of this analysis is in a rural setting, this also affects the types of procedures completed. It is common for general surgeons to perform C-sections and procedures corresponding with C-sections. Conversely, it is ordinary for small rural hospitals to not have 3
maternity and labor and delivery services. Therefore, procedures referring to maternity were removed from the rural general surgery list.
Table 1 displays the list of general surgery procedures along with the procedure code (ICD-9CM, FY07) used for estimation in this analysis. The final list was comprised of common procedures completed in a rural hospital general surgery programs survey. Eight Oklahoma rural hospitals along with a rural hospital in Indiana and one Virginia rural hospital were surveyed to gather an understanding of their surgery programs. These hospitals were selected first since they were rural, but they also had established general surgery programs. This survey contributed to the general surgery list used in this analysis and the average number of procedures that will be discussed later. This list is a generalized assumption of possible procedures. If current local general surgeons perform more procedures than those included on the list, the demand for general surgery could increase. However, if the current general surgeons complete fewer procedures, then the overall current demand will likely be lower. It is important to examine not only the current number of general surgeons, but the variety of procedures they perform.4
Table 1
Potential List of General Surgery Procedures Performed by Rural General Surgeons1
04.43
CARPAL TUNNEL RELEASE
45.73
RIGHT HEMICOLECTOMY
68.12
HYSTEROSCOPY
08.20
REMOVE EYELID LESION
47.01
LAP APPENDECTOMY
68.23
ENDOMETRIAL ABLATION
08.87
UPPER LID RHYTIDECTOMY
47.09
OTHER APPENDECTOMY
68.49
OTHER TOTAL HYSTERECTOMY
20.09
OTHER MYRINGOTOMY
48.36
POLYPECTOMY OF RECTUM
69.09
DIAGNOSTIC D & C
28.3
TONSILLECTOMY/ADENOIDECTOMY
49.46
HEMORRHOIDECTOMY
83.31
TENDON LESION EXCISION
34.91
THORACENTESIS
51.23
LAP CHOLECYSTECTOMY
85.21
BREAST LESION EXCISION
37.83
INSERT DUAL-CHAMBER PACE MAKER
53.00
UNILATERAL INGUINAL HERNIA REP
85.43
UNILATERAL SIMPLE MASTECTOMY
42.92
ESOPHAGEAL DILATION
53.41
UMBILICAL HERNIA REP
86.04
OTHER SKIN DRAINAGE
43.11
PERCUTANEOUS ENDOSC GASTROSTOMY
53.61
ABDOMINAL HERNIA REP
86.07
INSERTION VAD
45.13
OTHER SMALL INT. ENDOSCOPY (EGD)
53.69
OTHER ABDOMINAL HERNIA REP
86.21
EXCISION PILONIDAL LESION
45.16
EGD WITH CLOSED BIOPSY
54.21
LAPAROSCOPY
86.3
OTHER EXCISION OF SKIN LESION
45.23
COLONOSCOPY
57.32
OTHER CYSTOSCOPY
86.4
RADICAL EXCISION SKIN LESION
45.24
FLEXIBLE SIGMOIDOSCOPY
57.33
TRANSURETHAL BLADDER BX
98.51
ESWL KIDNEY/URETER/BLADDER
45.25
ENDOSCOPIC LARGE INT. BIOPSY
59.71
LEVATOR MUSCLE SUSPENSION
45.42
ENDOSCOPIC POLPECTOMY LARGE INT
66.29
ENDOSCOPIC FALLOPIAN TUBE NEC
1Based on procedures sampled from general rural hospital general surgery programs; procedure codes from ICD-9-CM (FY07)
5
Determining Need for General Surgeons
in the Sallisaw, Oklahoma, Medical Service Area
In order to estimate the number of possible general surgeries in Sallisaw, the medical service area was delineated as shown in Figure 1. To determine the medical service area, a number of factors were taken into consideration, including the proximity of existing hospital facilities and surgery services in nearby cities and the travel distances faced by residents of nearby communities. In particular, existing hospitals and surgery services in the surrounding communities, (Stigler, Stilwell, Ft. Smith, AR, Poteau, and Muskogee) likely draw residents of those nearby communities. Therefore, the primary medical service area for Sallisaw includes Sallisaw, Muldrow, and Vian while the secondary medical service area is comprised of Gore and Roland since there is the possibility that some individuals in these towns will choose to go to Sallisaw for their general surgery needs. The 2009 estimated population of the primary medical service area was 31,457 as shown in Table 2. The 2009 estimated secondary medical area population totals to 10,351. This yields a total population of 41,808 for both the primary and secondary service areas.
6
Hospital
County
Number of Beds
Memorial Hospital
Adair
46
Tahlequah City Hospital
Cherokee
100
Summit Medical Center
Crawford, AR
103
Haskell County Community Hospital
Haskell
25
Eastern Oklahoma Medical Center
LeFlore
84
Muskogee Community Hospital, LLC
Muskogee
45
Muskogee Regional Medical Center
Muskogee
255
Sequoyah Memorial Hospital
Sequoyah
41
Sparks Regional Medical Center
Sebastian, AR
510
St. Edward’s Mercy Medical Center
Sebastian, AR
336
Figure 1
Sallisaw, Oklahoma Medical Service Area
Primary Medical Services Area
Secondary Medical Services Area 7
The number of possible general surgeries generated in the Sallisaw, Oklahoma service area was estimated using the service area population data and research on the number of general surgeries for a specified age group [1]. Age group breakouts (by gender) and their corresponding number of general surgeries, based on the selected list in Table 1, are presented in Table 3. For instance, for males under age 15, the average number of general surgeries are 15.8 per 1,000 population per year [3]. Males between 15 and 44, however; typically have 20.4 per 1,000 population per year. Similar estimates per age group and gender are applied to the remaining male age groups and female age groups for both the primary and secondary service areas. Residents in the primary medical service area were estimated to need 2,103 total general surgery
Table 2
Sallisaw, Oklahoma Medical Service Area Population by Zip Code
Estimated 2009 Population
Totals
Primary Medical Service Area
74955, Sallisaw
13,689
74948, Muldrow
10,510
74962, Vian
7,258
31,457
Secondary Medical Service Area
74435, Gore
1,478
74954, Roland
8,873
10,351
Medical Service Area Total
41,808
Source: ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions 8
procedures per year, while residents of the secondary medical service area were estimated to need 692 general surgery procedures annually (Table 3).
In order to depict how many general surgeons a service area can support, it is imperative to determine on average how many total annual procedures rural general surgeons complete. The number of total procedures completed annually by rural general surgeons also varies substantially. The 2008 MGMA Physician Compensation and Production Survey estimated an average of 809 annual procedures completed by rural general surgeons [4]. However, the survey of rural general surgery programs, described earlier, estimated an average of 708 annual general surgery procedures completed by rural surgeons. Ultimately, the more procedures completed by one general surgeon annually, the fewer general surgeons are needed for the service area. For the purpose of this analysis, a range of full-time surgeons based on previous data will be identified.
Table 4 displays general surgery procedures for both primary and secondary service areas based on a range. If 90% of the primary service area and 10-15% of the secondary service area utilizes the local general surgery services, an estimated 1,962 to 1,997 annual general surgery procedures will be completed. This would yield 2.4 to 2.8 full-time general surgeons for the service area. The minimum for this estimation is based on 10% of the secondary service area with a general surgeon completing 809 procedures annually, and the maximum is based on 15% of the secondary service area with a general surgeon completing 708 general surgery procedures annually.
All assumptions and local conditions, including the actual usage levels in the primary and secondary medical service areas must be taken into consideration by decision-makers before determining if additional general surgeons could successfully locate in Sallisaw, Oklahoma. Further, the current number of general surgeons is not included in this analysis. Any evaluation 9
of the relative shortage or surplus of general surgeons must include details about the current levels of practicing surgeons and their overall service load. This analysis examines full time general surgeons. Therefore, it is important to consider both primary care physicians that perform surgeries occasionally and all part time general surgeons.
Summary
The analysis above presented the methodology and results of estimating the demand for general surgeons in Sallisaw, Oklahoma. The results suggest that, given a 90% primary service area usage rate and a 10-15% secondary service area usage rate, an estimated 2.4 to 2.8 general surgeons can be supported in the Sallisaw area. The actual number of general surgeons that the Sallisaw medical service area can support will vary based on changes to the service area shown in Figure 1 and on the usage rates depicted in Table 4. Estimates of these usage rates should be used in conjunction with the current status of the general surgery industry (including types of surgeries currently performed by existing general surgeons in Sallisaw) to determine the next steps for the community.
Many assumptions have been made in this analysis. These include items that may change, such as the population of the service area or service area delineation. For example, the service area depicted here may change due to the exit or entry of general surgery services from nearby communities. If this does occur, revised estimates of general surgeries should be made. The number of existing general surgeons is not addressed in this study. A close examination of current practicing general surgeons will be imperative to accurately assess whether or not the current population base can in fact support additional general surgeons.
As stated earlier the definition of general surgeon in terms of types of surgeries performed varies from facility to facility. Therefore, there is the possibility that existing general surgeons 10
complete more surgeries than listed earlier. If that is the case, the demand for general surgeries will increase. However, if a smaller variety of surgeries is performed locally, the overall demand will decrease for general surgeons. It is imperative to determine what surgeries are currently performed locally and if there is the opportunity to add services and surgeons.
All assumptions should be closely examined by local decision-makers to verify that they reflect local conditions. If additional local data are available, they should be included to derive the most realistic conclusion possible for the current situation. If further analysis is needed, contact your county extension office listed on the title page of this document.11
Table 3
Estimated Annual General Surgery Procedures Generated in the Sallisaw, Oklahoma, Medical Service Areas
PRIMARY MEDICAL SERVICE AREA
Male
Female
Procedures
Procedures
Age
2009
Population
Rate/1,000 population1
Procedures
2009
Population
Rate/1,000 population1
Procedures
Total Procedures
Under 15
3,311
15.8
52
3,185
14.9
47
100
15-44
6,416
20.4
131
6,366
48.6
309
440
45-64
3,869
90.2
349
4,066
119.3
485
834
65-74
1,041
185.7
193
1,222
182.4
223
416
75+
748
176.8
132
1,232
146.8
181
313
Total
15,385
858
16,072
1,246
2,103
SECONDARY MEDICAL SERVICE AREA
Male
Female
Procedures
Procedures
Age
2009
Population
Rate/1,000 population1
Procedures
2009
Population
Rate/1,000 population1
Procedures
Total Procedures
Under 15
1,089
15.8
17
1,048
14.9
16
33
15-44
2,111
20.4
43
2,095
48.6
102
145
45-64
1,273
90.2
115
1,338
119.3
160
274
65-74
342
185.7
64
402
182.4
73
137
75+
246
176.8
44
405
146.8
60
103
Total
5,063
282
5,288
410
692
1Source: The 2006 National Hospital Discharge Survey and 2006 National Survey of Ambulatory Surgery, and the selected surgery list in Table 1. Coefficients based on per 1,000 population [1,2]
12
Table 4
Estimated Number of General Surgery Procedures
By Local Residents in Sallisaw, Oklahoma Medical Service Areas
General Surgery Procedures from Residents of Primary Service Area
70%
75%
80%
85%
90%
95%
100%
General Surgery Procedures from Residents of Secondary Service Area
5%
1,507
1,612
1,717
1,823
1,928
2,033
2,138
10%
1,542
1,647
1,752
1,857
1,962
2,068
2,173
15%
1,576
1,681
1,787
1,892
1,997
2,102
2,207
20%
1,611
1,716
1,821
1,926
2,032
2,137
2,242
25%
1,645
1,751
1,856
1,961
2,066
2,171
2,277
30%
1,680
1,785
1,890
1,996
2,101
2,206
2,311
35%
1,715
1,820
1,925
2,030
2,135
2,241
2,346
40%
1,749
1,854
1,960
2,065
2,170
2,275
2,380
45%
1,784
1,889
1,994
2,099
2,205
2,310
2,415
50%
1,819
1,924
2,029
2,134
2,239
2,344
2,450
If 90% primary medical service area and 10to 15% secondary medical service area, then the procedures completed would be:
1,962 to 1,997 total general surgeries performed
for an estimated 2.4 to 2.8 Total Full-Time General Surgeons
Based on 809 average annual procedures via MGMA Physician Compensation and Production Survey and 708 data sampled from survey of rural hospitals [3,4] 13
References
[1] “2006 National Survey of Ambulatory Surgery,” Centers for Disease Control and Prevention, http://www.cdc.gov/nchs/nsas.htm.
[2] “2006 National Hospital Discharge Survey,” Centers for Disease Control and Prevention, http://www.cdc.gov/nchs.nsas.htm
[3] “The Economic Impact of a Rural General Surgeon and Model for Forecasting Need,” Eilrich, F., Sprague, J., Whitacre, B., Brooks, L., Doeksen, G., and St. Clair, C. National Center for Rural Health Works, Oklahoma State University, Oklahoma Cooperative Extension Service, 2010.
[4] “2008 MGMA Physician Compensation Survey,” Medical Group Management Association, www.mgma.com
[5] ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.

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An Analysis of the Demand for General Surgeons in the Sallisaw, Oklahoma, Medical Service Area
Rural Development
Oklahoma Cooperative Extension Service
Oklahoma State University
Oklahoma Office of Rural Health
Center for Rural Health
Oklahoma State University
December 2010 AE-10124
An Analysis of the Demand for General Surgeons
in the Sallisaw, Oklahoma, Medical Service Area
Brian E. Whitacre, Assistant Professor and Extension Economist, OSU, Stillwater
405-744-6083; FAX 405-744-9835
Lara Brooks, Assistant Extension State Specialist, OSU, Stillwater
405-744-6083
Fred Eilrich, Assistant Extension State Specialist, OSU, Stillwater
405-744-6083
Gerald A. Doeksen, Regents Professor and Extension Economist, OSU, Stillwater
405-744-6083
Tony Yates - Sequoyah County Extension Director, Sallisaw
(918) 775-4838
Jack Frye - District Rural Development Specialist, Ada
(580) 332-4100
Corie Kaiser, Assistant Director, Oklahoma Center for Rural Health, Oklahoma City
405-840-6500
Val Schott - Director, Oklahoma Center for Rural Health, Oklahoma City
405-840-6500
Rural Development
Oklahoma Cooperative Extension Service
Oklahoma State University
Oklahoma Office of Rural Health
Center for Rural Health
Oklahoma State University
December 20101
An Analysis of the Demand for General Surgeons
in the Sallisaw, Oklahoma, Medical Service Area
Introduction
This report will examine the need for general surgeons in the Sallisaw, Oklahoma, Medical Service Area. Specifically, the study will:
1. Determine the definition of general surgeon by identifying procedures completed;
2. Determine the medical service area and population;
3. Estimate the potential number of general surgeries in the service area; and
4. Estimate the total demand for full-time equivalent general surgeons in the medical service area.
No recommendations will be made. The information included in this report is designed to assist local decision-makers in assessing the need and potential for general surgery services.
Importance of Rural Surgery
General surgeons in rural hospitals have the ability to not only generate revenue in rural areas, but also keep patients in the community for a variety of surgeries, other services, and even retail opportunities. Therefore, it is most likely that if patients leave the community for general surgery, they will then have an increased opportunity to leave the community for other services. Also, the absence of a general surgery-linked emergency department volume can have effects on revenue and overall quality of local services.
This study does not account for the number of current general surgeons or physicians practicing surgery in the Sallisaw service area. In addition to noting the importance of providing this service, it is equally important to first examine the need for general surgery in a given 2
service area. Moreover, this analysis will determine an estimate of the number of full-time general surgeons this service area can support.
Methodology for Determining Need of General Surgeons
This study will determine the “need” for general surgeons using an estimation of population-based need. This approach will estimate the number of potential procedures performed by a general surgeon by developing age and gender-specific coefficients and applying them to a specific service area population. These coefficients were derived from data obtained by the National Hospital Discharge Survey (NHDS) and the National Surgery of Ambulatory Surgery (NSAS). Both surveys are available through the National Center for Health Statistics [1,2].
While it is possible that many rural hospital service areas do not have an ample population to support a full-time equivalent (FTE) general surgeon, the demand is often sufficient to support a part-time surgeon. Due to expectations, some hospitals have 24 hour call coverage that employs additional surgeons beyond what is necessary to meet the population’s demand. This methodology estimates only the population-based need and does not account for additional surgeons to fill extended call, or call coverage.
Defining the services of a general surgeon is much more difficult than defining other medical services. Eilrich et al. (2010) note the variance in general surgery definitions and types of procedures completed [3]. Several factors account for this variance. Experience, training, and personal tastes and preferences all determine the variety of procedures each general surgeon completes. Since the focus of this analysis is in a rural setting, this also affects the types of procedures completed. It is common for general surgeons to perform C-sections and procedures corresponding with C-sections. Conversely, it is ordinary for small rural hospitals to not have 3
maternity and labor and delivery services. Therefore, procedures referring to maternity were removed from the rural general surgery list.
Table 1 displays the list of general surgery procedures along with the procedure code (ICD-9CM, FY07) used for estimation in this analysis. The final list was comprised of common procedures completed in a rural hospital general surgery programs survey. Eight Oklahoma rural hospitals along with a rural hospital in Indiana and one Virginia rural hospital were surveyed to gather an understanding of their surgery programs. These hospitals were selected first since they were rural, but they also had established general surgery programs. This survey contributed to the general surgery list used in this analysis and the average number of procedures that will be discussed later. This list is a generalized assumption of possible procedures. If current local general surgeons perform more procedures than those included on the list, the demand for general surgery could increase. However, if the current general surgeons complete fewer procedures, then the overall current demand will likely be lower. It is important to examine not only the current number of general surgeons, but the variety of procedures they perform.4
Table 1
Potential List of General Surgery Procedures Performed by Rural General Surgeons1
04.43
CARPAL TUNNEL RELEASE
45.73
RIGHT HEMICOLECTOMY
68.12
HYSTEROSCOPY
08.20
REMOVE EYELID LESION
47.01
LAP APPENDECTOMY
68.23
ENDOMETRIAL ABLATION
08.87
UPPER LID RHYTIDECTOMY
47.09
OTHER APPENDECTOMY
68.49
OTHER TOTAL HYSTERECTOMY
20.09
OTHER MYRINGOTOMY
48.36
POLYPECTOMY OF RECTUM
69.09
DIAGNOSTIC D & C
28.3
TONSILLECTOMY/ADENOIDECTOMY
49.46
HEMORRHOIDECTOMY
83.31
TENDON LESION EXCISION
34.91
THORACENTESIS
51.23
LAP CHOLECYSTECTOMY
85.21
BREAST LESION EXCISION
37.83
INSERT DUAL-CHAMBER PACE MAKER
53.00
UNILATERAL INGUINAL HERNIA REP
85.43
UNILATERAL SIMPLE MASTECTOMY
42.92
ESOPHAGEAL DILATION
53.41
UMBILICAL HERNIA REP
86.04
OTHER SKIN DRAINAGE
43.11
PERCUTANEOUS ENDOSC GASTROSTOMY
53.61
ABDOMINAL HERNIA REP
86.07
INSERTION VAD
45.13
OTHER SMALL INT. ENDOSCOPY (EGD)
53.69
OTHER ABDOMINAL HERNIA REP
86.21
EXCISION PILONIDAL LESION
45.16
EGD WITH CLOSED BIOPSY
54.21
LAPAROSCOPY
86.3
OTHER EXCISION OF SKIN LESION
45.23
COLONOSCOPY
57.32
OTHER CYSTOSCOPY
86.4
RADICAL EXCISION SKIN LESION
45.24
FLEXIBLE SIGMOIDOSCOPY
57.33
TRANSURETHAL BLADDER BX
98.51
ESWL KIDNEY/URETER/BLADDER
45.25
ENDOSCOPIC LARGE INT. BIOPSY
59.71
LEVATOR MUSCLE SUSPENSION
45.42
ENDOSCOPIC POLPECTOMY LARGE INT
66.29
ENDOSCOPIC FALLOPIAN TUBE NEC
1Based on procedures sampled from general rural hospital general surgery programs; procedure codes from ICD-9-CM (FY07)
5
Determining Need for General Surgeons
in the Sallisaw, Oklahoma, Medical Service Area
In order to estimate the number of possible general surgeries in Sallisaw, the medical service area was delineated as shown in Figure 1. To determine the medical service area, a number of factors were taken into consideration, including the proximity of existing hospital facilities and surgery services in nearby cities and the travel distances faced by residents of nearby communities. In particular, existing hospitals and surgery services in the surrounding communities, (Stigler, Stilwell, Ft. Smith, AR, Poteau, and Muskogee) likely draw residents of those nearby communities. Therefore, the primary medical service area for Sallisaw includes Sallisaw, Muldrow, and Vian while the secondary medical service area is comprised of Gore and Roland since there is the possibility that some individuals in these towns will choose to go to Sallisaw for their general surgery needs. The 2009 estimated population of the primary medical service area was 31,457 as shown in Table 2. The 2009 estimated secondary medical area population totals to 10,351. This yields a total population of 41,808 for both the primary and secondary service areas.
6
Hospital
County
Number of Beds
Memorial Hospital
Adair
46
Tahlequah City Hospital
Cherokee
100
Summit Medical Center
Crawford, AR
103
Haskell County Community Hospital
Haskell
25
Eastern Oklahoma Medical Center
LeFlore
84
Muskogee Community Hospital, LLC
Muskogee
45
Muskogee Regional Medical Center
Muskogee
255
Sequoyah Memorial Hospital
Sequoyah
41
Sparks Regional Medical Center
Sebastian, AR
510
St. Edward’s Mercy Medical Center
Sebastian, AR
336
Figure 1
Sallisaw, Oklahoma Medical Service Area
Primary Medical Services Area
Secondary Medical Services Area 7
The number of possible general surgeries generated in the Sallisaw, Oklahoma service area was estimated using the service area population data and research on the number of general surgeries for a specified age group [1]. Age group breakouts (by gender) and their corresponding number of general surgeries, based on the selected list in Table 1, are presented in Table 3. For instance, for males under age 15, the average number of general surgeries are 15.8 per 1,000 population per year [3]. Males between 15 and 44, however; typically have 20.4 per 1,000 population per year. Similar estimates per age group and gender are applied to the remaining male age groups and female age groups for both the primary and secondary service areas. Residents in the primary medical service area were estimated to need 2,103 total general surgery
Table 2
Sallisaw, Oklahoma Medical Service Area Population by Zip Code
Estimated 2009 Population
Totals
Primary Medical Service Area
74955, Sallisaw
13,689
74948, Muldrow
10,510
74962, Vian
7,258
31,457
Secondary Medical Service Area
74435, Gore
1,478
74954, Roland
8,873
10,351
Medical Service Area Total
41,808
Source: ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions 8
procedures per year, while residents of the secondary medical service area were estimated to need 692 general surgery procedures annually (Table 3).
In order to depict how many general surgeons a service area can support, it is imperative to determine on average how many total annual procedures rural general surgeons complete. The number of total procedures completed annually by rural general surgeons also varies substantially. The 2008 MGMA Physician Compensation and Production Survey estimated an average of 809 annual procedures completed by rural general surgeons [4]. However, the survey of rural general surgery programs, described earlier, estimated an average of 708 annual general surgery procedures completed by rural surgeons. Ultimately, the more procedures completed by one general surgeon annually, the fewer general surgeons are needed for the service area. For the purpose of this analysis, a range of full-time surgeons based on previous data will be identified.
Table 4 displays general surgery procedures for both primary and secondary service areas based on a range. If 90% of the primary service area and 10-15% of the secondary service area utilizes the local general surgery services, an estimated 1,962 to 1,997 annual general surgery procedures will be completed. This would yield 2.4 to 2.8 full-time general surgeons for the service area. The minimum for this estimation is based on 10% of the secondary service area with a general surgeon completing 809 procedures annually, and the maximum is based on 15% of the secondary service area with a general surgeon completing 708 general surgery procedures annually.
All assumptions and local conditions, including the actual usage levels in the primary and secondary medical service areas must be taken into consideration by decision-makers before determining if additional general surgeons could successfully locate in Sallisaw, Oklahoma. Further, the current number of general surgeons is not included in this analysis. Any evaluation 9
of the relative shortage or surplus of general surgeons must include details about the current levels of practicing surgeons and their overall service load. This analysis examines full time general surgeons. Therefore, it is important to consider both primary care physicians that perform surgeries occasionally and all part time general surgeons.
Summary
The analysis above presented the methodology and results of estimating the demand for general surgeons in Sallisaw, Oklahoma. The results suggest that, given a 90% primary service area usage rate and a 10-15% secondary service area usage rate, an estimated 2.4 to 2.8 general surgeons can be supported in the Sallisaw area. The actual number of general surgeons that the Sallisaw medical service area can support will vary based on changes to the service area shown in Figure 1 and on the usage rates depicted in Table 4. Estimates of these usage rates should be used in conjunction with the current status of the general surgery industry (including types of surgeries currently performed by existing general surgeons in Sallisaw) to determine the next steps for the community.
Many assumptions have been made in this analysis. These include items that may change, such as the population of the service area or service area delineation. For example, the service area depicted here may change due to the exit or entry of general surgery services from nearby communities. If this does occur, revised estimates of general surgeries should be made. The number of existing general surgeons is not addressed in this study. A close examination of current practicing general surgeons will be imperative to accurately assess whether or not the current population base can in fact support additional general surgeons.
As stated earlier the definition of general surgeon in terms of types of surgeries performed varies from facility to facility. Therefore, there is the possibility that existing general surgeons 10
complete more surgeries than listed earlier. If that is the case, the demand for general surgeries will increase. However, if a smaller variety of surgeries is performed locally, the overall demand will decrease for general surgeons. It is imperative to determine what surgeries are currently performed locally and if there is the opportunity to add services and surgeons.
All assumptions should be closely examined by local decision-makers to verify that they reflect local conditions. If additional local data are available, they should be included to derive the most realistic conclusion possible for the current situation. If further analysis is needed, contact your county extension office listed on the title page of this document.11
Table 3
Estimated Annual General Surgery Procedures Generated in the Sallisaw, Oklahoma, Medical Service Areas
PRIMARY MEDICAL SERVICE AREA
Male
Female
Procedures
Procedures
Age
2009
Population
Rate/1,000 population1
Procedures
2009
Population
Rate/1,000 population1
Procedures
Total Procedures
Under 15
3,311
15.8
52
3,185
14.9
47
100
15-44
6,416
20.4
131
6,366
48.6
309
440
45-64
3,869
90.2
349
4,066
119.3
485
834
65-74
1,041
185.7
193
1,222
182.4
223
416
75+
748
176.8
132
1,232
146.8
181
313
Total
15,385
858
16,072
1,246
2,103
SECONDARY MEDICAL SERVICE AREA
Male
Female
Procedures
Procedures
Age
2009
Population
Rate/1,000 population1
Procedures
2009
Population
Rate/1,000 population1
Procedures
Total Procedures
Under 15
1,089
15.8
17
1,048
14.9
16
33
15-44
2,111
20.4
43
2,095
48.6
102
145
45-64
1,273
90.2
115
1,338
119.3
160
274
65-74
342
185.7
64
402
182.4
73
137
75+
246
176.8
44
405
146.8
60
103
Total
5,063
282
5,288
410
692
1Source: The 2006 National Hospital Discharge Survey and 2006 National Survey of Ambulatory Surgery, and the selected surgery list in Table 1. Coefficients based on per 1,000 population [1,2]
12
Table 4
Estimated Number of General Surgery Procedures
By Local Residents in Sallisaw, Oklahoma Medical Service Areas
General Surgery Procedures from Residents of Primary Service Area
70%
75%
80%
85%
90%
95%
100%
General Surgery Procedures from Residents of Secondary Service Area
5%
1,507
1,612
1,717
1,823
1,928
2,033
2,138
10%
1,542
1,647
1,752
1,857
1,962
2,068
2,173
15%
1,576
1,681
1,787
1,892
1,997
2,102
2,207
20%
1,611
1,716
1,821
1,926
2,032
2,137
2,242
25%
1,645
1,751
1,856
1,961
2,066
2,171
2,277
30%
1,680
1,785
1,890
1,996
2,101
2,206
2,311
35%
1,715
1,820
1,925
2,030
2,135
2,241
2,346
40%
1,749
1,854
1,960
2,065
2,170
2,275
2,380
45%
1,784
1,889
1,994
2,099
2,205
2,310
2,415
50%
1,819
1,924
2,029
2,134
2,239
2,344
2,450
If 90% primary medical service area and 10to 15% secondary medical service area, then the procedures completed would be:
1,962 to 1,997 total general surgeries performed
for an estimated 2.4 to 2.8 Total Full-Time General Surgeons
Based on 809 average annual procedures via MGMA Physician Compensation and Production Survey and 708 data sampled from survey of rural hospitals [3,4] 13
References
[1] “2006 National Survey of Ambulatory Surgery,” Centers for Disease Control and Prevention, http://www.cdc.gov/nchs/nsas.htm.
[2] “2006 National Hospital Discharge Survey,” Centers for Disease Control and Prevention, http://www.cdc.gov/nchs.nsas.htm
[3] “The Economic Impact of a Rural General Surgeon and Model for Forecasting Need,” Eilrich, F., Sprague, J., Whitacre, B., Brooks, L., Doeksen, G., and St. Clair, C. National Center for Rural Health Works, Oklahoma State University, Oklahoma Cooperative Extension Service, 2010.
[4] “2008 MGMA Physician Compensation Survey,” Medical Group Management Association, www.mgma.com
[5] ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.